Health Care Utilization and Finance
A1. Country to Compare
This research paper compares the U.S. health care system to the German health care system.
A2a. Coverage of Medications
According to the DPE (2016), the U.S. currently has a hybrid system of health care delivery that lacks universal coverage, and the country just recently passed legislation requiring healthcare coverage for nearly all groups of its population. As things are now, only those who have health insurance are allowed access to health care services. This situation has left out people who are unemployed and those who are retired, majority of whom cannot afford to purchase health care insurance and therefore access medications.Health Care Utilization and Finance Essay
The German system health care system, on the other hand, is based on the notion of “mutual aid societies” where every individual gains social benefits when social insurance is viewed as a principle of social unity (Ridic, G., Gleason, & Ridic, O., 2012). By this principle, the government is mandated to provide all citizens with a broad selection of social benefits, including medical care to children, senior citizens, and unemployed people.Health Care Utilization and Finance Essay
A2b. Referral to See a Specialist
According to Mehrotra, Forrest, and Lin (2011), three basic things are required to get a referral to see a specialist in the United States: a referral decision, specialty access, and tracking of the referral. Firstly, the primary care provider must reach the decision that the patient needs specialty care, which they are unable to provide at their health care facility. Once the decision is reached, the referring provider must initiate the referral by identifying a specialist to refer the patient to. In addition to that, the primary care giver must coordinate care by making sure that the referral is executed, and this involves sharing all relevant patient information with the specialty care provider.Health Care Utilization and Finance Essay
The health care system in Germany, on the other hand, allows patients direct, unrestricted access to specialty care (Schneider, et al., 2016). This has an adverse effect on the efficiency of the service delivery, as specialty care providers are often overwhelmed by the high demand for their services stemming from the direct access by patients. By allowing primary care providers to serve as “gatekeepers,” like in the U.S. (Mehrotra et al., 2011), Germany can realize greater efficiencies when it comes to delivery of specialty care.
A2c. Coverage for Preexisting Conditions
The health insurance coverage typically allows individuals freedom to choose a health care provider they prefer, and reimburses the money spent on a fee-for-service basis (Ridic, G., et al., 2012). Even though a majority of Americans have health insurance coverage, be it private or public, such coverage is uneven, premiums are increasing and the quality of the insurance policies is declining (DPE, 2016).Health Care Utilization and Finance Essay
Health care insurance coverage in Germany is largely decentralized since it is provided through several relatively small, independent plans (Ridic, G., et al., 2012). In this regard, the German health care system is identical to that of the U.S. where large groups of workers, self-insurers, and health care providers make arrangements without direct government involvement.
A3. Finance Implications for Healthcare Delivery
A key feature of the American health care system is a financial plan that pays for health care services fee-for-service basis. As patients with health care coverage had the right to choose who they want to serve them, the need for new managed care grew to restrict these choices and drive down the high health care expenditures incurred. This lead President Obama to sign into law the Affordable Care Act in March, 2010 (DPE, 2016).
There is a general sense of agreement in the German population that all citizens should get medical services, irrespective of their ability to pay. According to Ridic, G., et al. (2012), in Germany, medical costs are deducted from the salaries and wages of “sickness fund” members. The success of the strategy is based upon the continued increase of employee income as well as the success of the discussions between the members of the sickness fund and medical experts.Health Care Utilization and Finance Essay
- DPE. (2016, August). Fact sheet 2016: The U.S. health care system: An International perspective-DPEAFLCIO. Retrieved from http://dpeaflcio.org/programs-publications/issue-fact-sheets/the-u-s-health-care-system-an-international-perspective/
- Mehrotra, A., Forrest, C. B., & Lin, C. Y. (2011). Dropping the baton: Specialty referrals in the United States. Milbank Quarterly, 89(1), 39-68. Retrieved from http://www.ncbi.nlm.nih.gov
- Ridic, G., Gleason, S., & Ridic, O. (2012). Comparisons of health care systems in the United States, Germany and Canada. Materia Socio-Medica, 24(2), 112-120. Retrieved from http://www.ncbi.nlm.nih.gov
- Schneider, A., Donnachie, E., Tauscher, M., Gerlach, R., Maier, W., Mielck, A., … & Mehring, M. (2016). Costs of coordinated versus uncoordinated care in Germany: Results of a routine data analysis in Bavaria. BMJ Open, 6(6), e011621. Retrieved from http://bmjopen.bmj.com. Health Care Utilization and Finance Essay